Primary and secondary nocturnal enuresis Flashcards
What does enuresis mean?
Involuntary urination
What is nocturnal enuresis?
Bed wetting
What is diurnal enuresis?
Inability to control bladder function during the day
By what age do most people have control of daytime urination?
2 years old
By what age do most people have control of night time urination?
3-4 years old
What is Primary nocturnal enuresis?
This is where the child has never managed to be consistently dry at night
What is the most common cause of primary nocturnal enuresis?
Variation on normal development, particularly if the child is younger than 5 years.
What is common with a child who has primary nocturnal enuresis?
A family history of delayed dry nights
What is the management of a child younger than 5 with primary nocturnal enuresis?
Reassurance
What are other possible causes of primary nocturnal enuresis?
Overactive bladder. .
Fluid intake prior to bedtime-
Failure to wake due to particularly deep sleep and underdeveloped bladder signals
Psychological distress-
Drinking which fluids could result in primary nocturnal enuresis?
Fizzy drinks
Juice
Caffeine
(drinks with a diuretic effect)
What psychological distress could result in primary nocturnal enuresis?
Low self esteem
Too much pressure or stress at home or school
What is secondary nocturnal enuresis?
A child begins wetting the bed when they have previously been dry for at least 6 months.
How long had the child be dry for before wetting the bed again with secondary nocturnal enuresis?
6 months
What is secondary nocturnal enuresis more indicative of than primary nocturnal enuresis?
Secondary is more indicative of underlying illness than primary enuresis
What are possible causes of secondary nocturnal enuresis?
- Urinary tract infection
- Constipation
- Type 1 diabetes
- New psychosocial problems (e.g. stress in family or school life)
- Maltreatment
What is diurnal enuresis?
Daytime incontinence.
When does diurnal enuresis occur?
When the person has become dry at night but still has episodes of urinary incontinence during the day.
Who is more commonly affected by diurnal enuresis?
Girls
What are the most common causes of diurnal enuresis?
Incontinence- Stress and Urge incontinence
What are other possible causes of diurnal enuresis?
- Recurrent urinary tract infections
- Psychosocial problems
- Constipation
What is the initial management of enuresis?
look for possible underlying causes/triggers
• constipation
• diabetes mellitus
• UTI if recent onset
What is general advice for the management of enuresis?
- fluid intake
- toileting patterns: encourage to empty bladder regularly during the day and before sleep
- lifting and waking
- reward systems (e.g. Star charts)
What is usually first line for children?
Enuresis alarm
What is an enuresis alarm?
Have sensor pads that sense wetness and set off an alarm, waking the child up
What drug management can be given if short term control is needed or the enuresis alarm doesn’t work?
Desmopressin
What is the function of desmopressin?
It reduces the volume of urine produced by the kidneys
